Utility of ultrasound in acute pancreatitis

A Letter to the Editor to this article was published on 27 March 2020

Abstract

Ultrasound plays an essential role in the initial evaluation of patients with suspected or confirmed acute pancreatitis. In addition to evaluation of the pancreatic parenchyma, ultrasound is used for assessment of the gallbladder, biliary tree, peripancreatic tissues, and regional vascular structures. While enlarged and edematous pancreas are classic sonographic features of acute pancreatitis, the pancreas may appear sonographically normal in the setting of acute pancreatitis. Nonetheless, sonographic evaluation in this setting is valuable because assessment for etiologic factors such as gallstones or evidence of biliary obstruction are best performed with ultrasound. Complications of pancreatitis such as peripancreatic fluid collections, venous thrombosis, or arterial pseudoaneurysm can be identified with careful and focused ultrasound examination. Knowledge of various scanning techniques can help to mitigate some of the commonly encountered barriers to sonographic visualization of the pancreas and right upper quadrant structures. Ultrasound can also be used for guidance of percutaneous treatment such as drainage of fluid collections or pseudoaneurysm thrombosis. Difficulty in differentiating edematous from necrotizing pancreatitis can be mitigated with the use of contrast-enhanced ultrasound to assess pancreatic parenchymal enhancement.

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References

  1. 1.

    Tenner S, Baillie J, Dewitt J, Vege SS (2013) American college of gastroenterology guideline: Management of acute pancreatitis. Am J Gastroenterol 108: 1400-1415.

    CAS  PubMed  Google Scholar 

  2. 2.

    Waller A, Long B, Koyfman A, Gottlieb M (2018) Acute Pancreatitis: Updates for Emergency Clinicians. J Emerg Med 55: 769-779.

    PubMed  Google Scholar 

  3. 3.

    Johnson C, Lévy P (2010) Detection of Gallstones in Acute Pancreatitis: When and How? Pancreatology 10: 27-32.

    PubMed  Google Scholar 

  4. 4.

    Schepers NJ, Besselink MGH, van Santvoort HC, Bakker OJ, Bruno MJ (2013) Early management of acute pancreatitis. Best Pract Res Clin Gastroenterol 27: 727-743.

    PubMed  Google Scholar 

  5. 5.

    Porter KK, Zaheer A, Kamel IR, Horowitz JM, Arif-Tiwari H, et al. (2019) ACR Appropriateness Criteria® Acute Pancreatitis. J Am Coll Radiol 16: S316-S330.

    PubMed  Google Scholar 

  6. 6.

    Dimastromatteo J, Brentnall T, Kelly KA (2017) Imaging in pancreatic disease. Nat Rev Gastroenterol Hepatol 14: 97-109.

    CAS  PubMed  Google Scholar 

  7. 7.

    Moon J, Cha S, Cheon Y, Ahn H, Kim Y, et al. (2003) The detection of bile duct stones in suspected gallstone pancreatitis: Comparison of Mrcp, Ercp, and intraductal us. Gastroenterology 124: A32.

    Google Scholar 

  8. 8.

    Hertzberg BS, Middleton WD, Preceded by: Middleton WD Ultrasound : The Requisites.

  9. 9.

    Lee JS, Kim SH, Jun DW, Han JH, Jang EC, et al. (2009) Clinical implications of fatty pancreas: Correlations between fatty pancreas and metabolic syndrome. World J Gastroenterol 15: 1869.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    Hung C-S, Tseng P-H, Tu C-H, Chen C-C, Liao W-C, et al. (2018) Increased Pancreatic Echogenicity with US: Relationship to Glycemic Progression and Incident Diabetes. Radiology 287: 853-863.

    PubMed  Google Scholar 

  11. 11.

    Balthazar EJ (2002) Acute Pancreatitis: Assessment of Severity with Clinical and CT Evaluation. Radiology 223: 603-613.

    PubMed  Google Scholar 

  12. 12.

    Bollen TL, van Santvoort HC, Besselink MGH, van Es WH, Gooszen HG, et al. (2007) Update on acute pancreatitis: ultrasound, computed tomography, and magnetic resonance imaging features. Semin Ultrasound CT MR 28: 371-83.

    PubMed  Google Scholar 

  13. 13.

    Hadidi A (1983) Pancreatic duct diameter: Sonographic measurement in normal subjects. J Clin Ultrasound 11: 17-22.

    CAS  PubMed  Google Scholar 

  14. 14.

    Edge MD, Hoteit M, Patel AP, Wang X, Baumgarten DA, et al. (2007) Clinical significance of main pancreatic duct dilation on computed tomography: Single and double duct dilation RAPID COMMUNICATION. World J Gastroenterol 13: 1701-1705.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    O’Connor OJ, McWilliams S, Maher MM (2011) Imaging of Acute Pancreatitis. Am J Roentgenol 197: W221-W225.

    Google Scholar 

  16. 16.

    Scaglione M, Casciani E, Pinto A, Andreoli C, De Vargas M, et al. (2008) Imaging Assessment of Acute Pancreatitis: A Review. Semin Ultrasound, CT MRI 29: 322-340.

    Google Scholar 

  17. 17.

    To’o KJ, Raman SS, Yu NC, Kim YJ, Crawford T, et al. (2005) Pancreatic and Peripancreatic Diseases Mimicking Primary Pancreatic Neoplasia. RadioGraphics 24: 949-965.

    Google Scholar 

  18. 18.

    Bowman AW, Bolan CW (2019) MRI evaluation of pancreatic ductal adenocarcinoma: diagnosis, mimics, and staging. Abdom Radiol 44: 936-949.

    Google Scholar 

  19. 19.

    Suramo I, Päivänsalo M, Myllylä V (1984) Cranio-caudal movements of the liver, pancreas and kidneys in respiration. Acta Radiol Diagn (Stockh) 25: 129-31.

    CAS  Google Scholar 

  20. 20.

    Rumack CM, Wilson SR, Charboneau JW (2005) Diagnostic Ultrasound. Elsevier Mosby.

  21. 21.

    Neoptolemos JP, Hall AW, Finlay DF, Berry JM, Carr-Locke DL, et al. (1984) The urgent diagnosis of gallstones in acute pancreatitis: A prospective study of three methods. Br J Surg 71: 230-233.

    CAS  PubMed  Google Scholar 

  22. 22.

    Lankisch PG, Apte M, Banks PA (2015) Acute pancreatitis. Lancet 386: 85-96.

    PubMed  Google Scholar 

  23. 23.

    Ratanaprasatporn L, Uyeda JW, Wortman JR, Richardson I, Sodickson AD (2018) Multimodality Imaging, including Dual-Energy CT, in the Evaluation of Gallbladder Disease. RadioGraphics 38: 75-89.

    PubMed  Google Scholar 

  24. 24.

    Vilgrain V, Palazzo L (2001) Choledocholithiasis: role of US and endoscopic ultrasound. Abdom Imaging 26: 7-14.

    CAS  PubMed  Google Scholar 

  25. 25.

    Mitchell SE, Clark RA (1984) A comparison of computed tomography and sonography in choledocholithiasis. AJR Am J Roentgenol 142: 729-33.

    CAS  PubMed  Google Scholar 

  26. 26.

    Gross BH, Harter LP, Gore RM, Callen PW, Filly RA, et al. (1983) Ultrasonic evaluation of common bile duct stones: prospective comparison with endoscopic retrograde cholangiopancreatography. Radiology 146: 471-4.

    CAS  PubMed  Google Scholar 

  27. 27.

    Sugiyama M, Atomi Y (1997) Endoscopic ultrasonography for diagnosing choledocholithiasis: a prospective comparative study with ultrasonography and computed tomography. Gastrointest Endosc 45: 143-146.

    CAS  PubMed  Google Scholar 

  28. 28.

    van Santvoort H, Bakker O, Besselink M, Bollen T, Fischer K, et al. (2011) Prediction of common bile duct stones in the earliest stages of acute biliary pancreatitis. Endoscopy 43: 8-13.

    PubMed  Google Scholar 

  29. 29.

    Şurlin V, Săftoiu A, Dumitrescu D (2014) Imaging tests for accurate diagnosis of acute biliary pancreatitis. World J Gastroenterol 20: 16544-9.

    PubMed  PubMed Central  Google Scholar 

  30. 30.

    Gore RM, Levine MS (2010) High-Yield Imaging. Gastrointestinal. Saunders/Elsevier.

    Google Scholar 

  31. 31.

    Majeed AW, Ross B, Johnson AG, Reed MWR (1999) Common duct diameter as an independent predictor of choledocholithiasis: Is it useful? Clin Radiol 54: 170-172.

    CAS  PubMed  Google Scholar 

  32. 32.

    Boys JA, Doorly MG, Zehetner J, Dhanireddy KK, Senagore AJ (2014) Can ultrasound common bile duct diameter predict common bile duct stones in the setting of acute cholecystitis? Am J Surg 207: 432-435.

    PubMed  Google Scholar 

  33. 33.

    Hunt DR, Reiter L, Scott AJ (1990) Pre-operative ultrasound measurement of bile duct diameter: Basis for selective cholangiography. Aust N Z J Surg 60: 189-192.

    CAS  PubMed  Google Scholar 

  34. 34.

    Ko CW, Sekijima JH, Lee SP (1999) Biliary Sludge. Ann Intern Med 130: 301.

    CAS  PubMed  Google Scholar 

  35. 35.

    Lee SP, Nicholls JF, Park HZ (1992) Biliary Sludge as a Cause of Acute Pancreatitis. N Engl J Med 326: 589-593.

    CAS  PubMed  Google Scholar 

  36. 36.

    Kirby JM, Vora P, Midia M, Rawlinson J Vascular complications of pancreatitis: imaging and intervention. Cardiovasc Intervent Radiol 31: 957-970.

    Google Scholar 

  37. 37.

    Bergert H, Hinterseher I, Kersting S, Leonhardt J, Bloomenthal A, et al. (2005) Management and outcome of hemorrhage due to arterial pseudoaneurysms in pancreatitis. Surgery 137: 323-328.

    PubMed  Google Scholar 

  38. 38.

    Silverstein W, Isikoff MB, Hill MC, Barkin J (1981) Diagnostic imaging of acute pancreatitis: prospective study using CT and sonography. AJR Am J Roentgenol 137: 497-502.

    CAS  PubMed  Google Scholar 

  39. 39.

    Busireddy KK, AlObaidy M, Ramalho M, Kalubowila J, Baodong L, et al. (2014) Pancreatitis-imaging approach. World J Gastrointest Pathophysiol 5: 252-70.

    PubMed  Google Scholar 

  40. 40.

    Foster BR, Jensen KK, Bakis G, Shaaban AM, Coakley FV. (2016) Revised Atlanta Classification for Acute Pancreatitis: A Pictorial Essay. RadioGraphics 36: 675-687.

    PubMed  Google Scholar 

  41. 41.

    Freeny PC, Hauptmann E, Althaus SJ, Traverso LW, Sinanan M (1998) Percutaneous CT-guided catheter drainage of infected acute necrotizing pancreatitis: techniques and results. Am J Roentgenol 170: 969-975.

    CAS  Google Scholar 

  42. 42.

    De Rosa A, Gomez D, Pollock JG, Bungay P, De Nunzio M, et al. (2012) The radiological management of pseudoaneurysms complicating pancreatitis. JOP 13: 660-6.

    PubMed  Google Scholar 

  43. 43.

    Ripollés T, Martínez MJ, López E, Castelló I, Delgado F (2010) Contrast-enhanced ultrasound in the staging of acute pancreatitis. Eur Radiol 20: 2518-2523.

    PubMed  Google Scholar 

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Correspondence to David P. Burrowes.

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Burrowes, D.P., Choi, H.H., Rodgers, S.K. et al. Utility of ultrasound in acute pancreatitis. Abdom Radiol 45, 1253–1264 (2020). https://doi.org/10.1007/s00261-019-02364-x

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Keywords

  • Pancreatitis
  • Gallstones
  • Ultrasound
  • Sonographic technique
  • Bile duct